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Rickettsia, Orientia, Ehrlichia, Anaplasma, Coxiella and Bartonella History of Rickettsial Diseases Epidemic typhus - 16th century Associated with wars and famine WWI and WWII - 100,000 people affected Ricketts identifies causative agent of Rocky Mountain spotted fever - 20th century

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History of rickettsial diseases l.jpg
History of Rickettsial Diseases Bartonella

  • Epidemic typhus - 16th century

  • Associated with wars and famine

  • WWI and WWII - 100,000 people affected

  • Ricketts identifies causative agent of Rocky Mountain spotted fever - 20th century

  • Arthropod vectors identified

  • Arthropod control measures instituted


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“Typhus is not dead. It will continue to break into the open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”

Hans Zinsser in Rats, Lice and History


Rickettsia orientia ehrlichia anaplasma and coxiella biology l.jpg
Rickettsia, Orientia, Ehrlichia Anaplasma open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases” and Coxiella Biology

  • Small obligate intracellular parasites

  • Once considered to be viruses

  • Separate unrelated genera

  • Gram-negative bacteria

    • Stain poorly with Gram stain (Giemsa)

  • “Energy parasites”

    • Transport system for ATP

  • Reservoirs - animals, insects and humans

  • Arthropod vectors (except Coxiella)


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Disease open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”OrganismVectorReservoir

Rocky Mountain R. rickettsii Tick Ticks, rodents

spotted fever

Ehrlichiosis E. chaffeensis Tick Deer

E ewingii Tick Deer

Anaplasmosis A. phagocytophlium Tick Small mammals

Rickettsialpox R. akari Mite Mites, rodents

Scrub typhus O. tsutsugamushi Mite Mites, rodents

Epidemic typhus R. prowazekii Louse Humans, squirrel

fleas, flying

squirrels

Murine typhus R. thypi Flea Rodents

Q fever C. burnetii None Cattle, sheep,

(ticks in animals) goats, cats


Rickettsia and orientia n b orientia was formerly rickettsia l.jpg

Rickettsia and Orientia open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”N.B.Orientia was formerly Rickettsia


Replication of rickettsia and orientia l.jpg
Replication of open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”Rickettsia and Orientia

  • Infect endothelial in small blood vessels - Induced phagocytosis

  • Lysis of phagosome and entry into cytoplasm - Phospholipase

  • Replication

  • Release


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Groups of Rickettsia Based on Antigenic Structure open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”

Spotted fever group:

R. rickettsii Rocky Mountain spotted fever Western hemisphere

R. akari Rickettsialpox USA, former Soviet Union

R. conorii Boutonneuse fever Mediterranean countries, Africa, India, Southwest Asia

R. sibirica Siberian tick typhus Siberia, Mongolia,

northern China

R. australia Australian tick typhus Australia

R. japonica Oriental spotted fever Japan

Typhus group:

R. prowazekii Epidemic typhus South America and Africa

Recrudescent typhus Worldwide

Sporadic typhus United States

R. typhi Murine typhus Worldwide

Scrub typhus group:

O. tsutsugamushi Scrub typhus Asia, northern Australia,

Pacific Islands


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Pathogenesis and Immunity open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”

  • No known toxins or immunopathology

  • Destruction of cells

    • Leakage of blood into tissues (rash)

    • Organ and tissue damage

  • Humoral and cell mediated immunity important for recovery

    • Antibody-opsonized bacteria are killed

    • CMI develops


Spotted fever group l.jpg

Spotted Fever Group open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”


Rickettsia rickettsii l.jpg
Rickettsia rickettsii open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”

  • Rocky Mountain spotted fever

Fluorescent Ab staining

Vector - Tick

From: G. Wistreich, Microbiology Perspectives, Prentice Hall


Epidemiology r rickettsii rocky mountain spotted fever l.jpg
Epidemiology - open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”R. rickettsiiRocky Mountain Spotted Fever

  • Most common rickettsial infection in USA

    • 400 -700 cases annually

    • South Central USA


Epidemiology r rickettsii rocky mountain spotted fever13 l.jpg
Epidemiology - open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”R. rickettsiiRocky Mountain Spotted Fever

  • Most common rickettsial infection in USA

    • 400 -700 cases annually

    • South Central USA

  • Most common from April - September

  • Vector - Ixodid (hard) tick via saliva

    • Prolonged exposure to tick is necessary

  • Reservoirs - ticks (transovarian passage) and rodents

    • Humans are accidentally infected


Epidemiology r rickettsii rocky mountain spotted fever14 l.jpg
Epidemiology - open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”R. rickettsiiRocky Mountain Spotted Fever


Clinical syndrome rocky mountain spotted fever l.jpg
Clinical Syndrome - Rocky Mountain Spotted Fever open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”

  • Incubation period - 2 to 12 days

  • Abrupt onset fever, chills, headache and myalgia

  • Rash appears 2 -3 days later in most (90%) patients

    • Begins on hands and feet and spreads to trunk (centripetal spread)

    • Palms and soles common

    • Maculopapular but can become petechial or hemorrhagic


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Rash of Rocky Mountain Spotted Fever open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”


Clinical syndrome rocky mountain spotted fever17 l.jpg
Clinical Syndrome - Rocky Mountain Spotted Fever open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”

  • Incubation period - 2 to 12 days

  • Abrupt onset fever, chills headache and myalgia

  • Rash appears 2 -3 days later in most (90%) patients

    • Begins on hands and feet and spreads to trunk (centripetal spread)

    • Palms and soles common

    • Maculopapular but can become petechial or hemorrhagic

  • Complications from widespread vasculitis

    • Gastrointestinal, respiratory, seizures, coma, renal failure

    • Most common when rash does not appear

  • Mortality in untreated cases - 20%


Laboratory diagnosis r rickettsii l.jpg
Laboratory Diagnosis - open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”R. rickettsii

  • Initial diagnosis - clinical grounds

  • Fluorescent Ab test for Ag in punch biopsy - reference labs

  • PCR based tests - reference labs

  • Weil-Felix test - no longer recommended

  • Serology

    • Indirect fluorescent Ab test for Ab

    • Latex agglutination test for Ab


Treatment prevention and control r rickettsii l.jpg
Treatment, Prevention and Control open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”R. rickettsii

  • Tetracycline and chloramphenicol

    • Prompt treatment reduces morbidity and mortality

  • No vaccine

  • Prevention of tick bites (protective clothing, insect repellents)

  • Prompt removal of ticks

  • Can’t control the reservoir


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Consequences of Delayed Diagnosis of RMSF open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”

  • In Oklahoma on July 7 a 6 year-old presented with 1-day history of fever, headache, myalgia, and a macular rash on the arms, legs, palms, and soles

  • On July 1 a tick had been removed from the patients neck

  • Diagnosis: Viral illness; patient given oral cephalosporin

  • On July 11 the patient was hospitalized with dehydration, irritability, confusion and throbocytopenia

  • On July 12-13 patient developed disseminated intravascular coagulation and iv doxycycline was administered.

  • The patient subsequently developed gangrene, requiring limb amputation and removal of the upper stomach and distal esophagus

  • August 19 the patient died.

  • Serum samples from July 12 and August 3 tested positive for antibodies to R. rickettsii


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Rickettsia akari open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”

  • Rickettsialpox


Epidemiology r akari rickettsialpox l.jpg
Epidemiology - open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”R. akariRickettsialpox

  • Sporadic infection in USA

  • Vector - house mite

  • Reservoir - mites (transovarian transmission) and mice

  • Humans accidentally infected


Clinical syndrome rickettsialpox l.jpg
Clinical Syndrome -Rickettsialpox open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”

  • Phase I (1 week incubation period)

    • papule at bite site

    • Eschar formation

  • Phase II (1 -3 week later)

    • Sudden onset of fever, chills headache and myaglia

    • Generalized rash - papulovessicular, crusts

  • Mild disease; fatalities are rare


Laboratory diagnosis r akari l.jpg
Laboratory Diagnosis - open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”R. akari

  • Not available except in reference laboratories


Treatment prevention and control r akari l.jpg
Treatment, Prevention and Control open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”R. akari

  • Tetracycline and chloramphenicol

  • Control of mouse population


Typhus group l.jpg

Typhus Group open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”


Rickettsia prowazekii l.jpg
Rickettsia prowazekii open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”

  • Epidemic typhus

  • Brill-Zinsser disease

Fluorescent-Ab staining

Vector - Louse

From: G. Wistreich, Microbiology Perspectives, Prentice Hall


Epidemiology r prowazekii epidemic typhus l.jpg
Epidemiology - open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”R. prowazekiiEpidemic typhus

  • Associated with unsanitary conditions

    • War, famine, etc.

  • Vector - human body louse

    • Bacteria found in feces

  • Reservoir

    • Primarily humans (epidemic form)

    • No transovarian transmission in the louse

  • Sporadic disease in Southeastern USA

    • Reservoir - flying squirrels

    • Vector - squirrel fleas


Clinical syndrome epidemic typhus l.jpg
Clinical Syndrome - Epidemic typhus open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”

  • Incubation period approximately 1 week

  • Sudden onset of fever, chills, headache and myalgia

  • After 1 week rash

    • Maculopapular progressing to petechial or hemorrhagic

    • First on trunk and spreads to extremities (centrifugal spread)

  • Complications

    • Myocarditis, stupor, delirium (Greek “typhos” = smoke)

  • Recovery may take months

  • Mortality rate can be high (60-70%)


Clinical syndrome brill zinsser disease l.jpg
Clinical Syndrome - Brill-Zinsser Disease open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”

  • Recrudescent epidemic typhus

    • Commonly seen in those exposed during WWII

  • Disease is similar to epidemic typhus but milder

  • Rash is rare

  • High index of suspicion need for diagnosis


Laboratory diagnosis r prowazekii l.jpg
Laboratory Diagnosis - open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”R. prowazekii

  • Weil-Felix antibodies - not recommended

  • Isolation possible but dangerous

  • Serology

    • Indirect fluorescent Ab and latex agglutination tests

    • Epidemic typhus - IgM followed by IgG Abs

    • Brill-Zinsser - IgG anamnestic response


Treatment prevention and control r prowazekii l.jpg
Treatment, prevention and Control open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”R. prowazekii

  • Tetracycline and chloramphenicol

  • Louse control measures

  • Vaccine available for high risk populations


Rickettsia typhi l.jpg
Rickettsia typhi open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”

  • Murine or endemic typhus


Epidemiology r typhi murine or endemic typhus l.jpg
Epidemiology - open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”R. typhiMurine or endemic typhus

  • Occurs worldwide

  • Vector - rat flea

    • Bacteria in feces

  • Reservoir - rats

    • No transovarian transmission

    • Normal cycle - rat to flea to rat

  • Humans accidentally infected


Clinical syndrome murine typhus l.jpg
Clinical Syndrome- Murine Typhus open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”

  • Incubation period 1 - 2 weeks

  • Sudden onset of fever, chills, headache and myalgia

  • Rash in most cases

    • Begins on trunk and spreads to extremities (centrifugal spread)

  • Mild disease - resolves even if untreated


Laboratory diagnosis r typhi l.jpg
Laboratory Diagnosis - open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”R. typhi

  • Serology

    • Indirect fluorescent antibody test


Treatment prevention and control r typhi l.jpg
Treatment, Prevention and Control open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”R. typhi

  • Tetracycline and chloramphenicol

  • Control rodent reservoir


Scrub typhus group l.jpg

Scrub Typhus Group open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”


Orientsia rickettsia tsutsugamushi l.jpg
Orientsia (Rickettsia) tsutsugamushi open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”

  • Scrub typhus

  • Japanese “tsutsuga” = small and dangerous and “mushi” = creature

  • “Scrub” - associated with terrain with scrub vegetation


Epidemiology o tsutstugamushi scrub typhus l.jpg
Epidemiology - open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”O. tsutstugamushiScrub Typhus

  • Vector - chiggers (mite larva)

  • Reservoir - chiggers and rats

    • Transovarian transmission

    • Normal cycle - rat to mite to rat

  • Humans are accidentally infected


Clinical syndrome scrub typhus l.jpg
Clinical Syndrome - Scrub Typhus open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”

  • Incubation period - 1 to 3 weeks

  • Sudden onset of fever, chills, headache and myalgia

  • Maculopapular rash

    • Begins on trunk and spreads to extremities (centrifugal spread)

  • Mortality rates variable


Laboratory diagnosis o tsutsugamushi l.jpg
Laboratory Diagnosis - open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”O. tsutsugamushi

  • Serology


Treatment prevention and control o tsutsugamushi l.jpg
Treatment, Prevention and Control open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”O. tsutsugamushi

  • Tetracycline and chloramphenicol

  • Measures to avoid exposure to chiggers


Ehrlichia and anaplasma l.jpg

Ehrlichia open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases” and Anaplasma


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Replication of open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”Ehrlichia and Anaplasma

  • Infection of leukocytes - Phagocytosis

  • Inhibition of phagosome-lysosome fusion

  • Growth within phagosome - Morula

  • Lysis of cell


Epidemiology ehrlichia l.jpg
Epidemiology - open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”Ehrlichia


Ehrlichia chaffeensis l.jpg
Ehrlichia chaffeensis open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”

  • Human monocytic ehrlichiosis

Vector - Tick

From: Koneman et al. Color Atlas and Textbook of Diagnostic Microbiology, Lippincott


Clinical syndrome human monocytic ehrlichiosis e chaffeensis l.jpg
Clinical Syndrome - Human Monocytic Ehrlichiosis open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”E. chaffeensis

  • Sudden onset of fever, chills, headache and myalgia

  • No rash in most (80%) patients

  • Leukopenia, thrombocytopenia and elevated serum transaminases

  • Mortality rates low (<5%)


Laboratory diagnosis e chaffeensis l.jpg
Laboratory Diagnosis - open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”E. chaffeensis

  • Microscopic observation of morula in blood smears is rare

  • Culture is possible but rarely done

  • Serology is most common

  • DNA probes are available

From: Koneman et al. Color Atlas and Textbook of Diagnostic Microbiology, Lippincott


Treatment prevention and control e chaffeensis l.jpg
Treatment, Prevention and Control open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases”E. chaffeensis

  • Doxycycline

  • Avoidance of ticks


Ehrlichia ewingii and anaplasma phgocytophilium l.jpg
Ehrlichia ewingii open whenever human stupidity and brutality give it a chance, as most likely they occasionally will. But its freedom of action is being restricted and more and more it will be confined, like other savage creatures, in the zoologic gardens of controlled diseases” and Anaplasma phgocytophilium

  • Human granulocytic ehrlichiosis and anaplsmosis

Vector - Tick

From: Koneman et al. Color Atlas and Textbook of Diagnostic Microbiology, Lippincott


Slide53 l.jpg
Clinical Syndrome - Human Granulocytic Ehrlichiosis or AnaplasmosisE. ewingii or Anaplasma phgocytophilium

  • Sudden onset of fever, chills, headache and myalgia

  • No rash in most (80%) patients

  • Leukopenia , thrombocytopenia and elevated serum transaminases

  • Mortality rates low (<5%)


Laboratory diagnosis e ewingii and a phagocytophilum l.jpg
Laboratory Diagnosis - AnaplasmosisE. ewingii and A. phagocytophilum

  • Microscopic observation of morula in blood smears is rare

  • Culture is possible but rarely done

  • Serology is most common

  • DNA probes are available

From: Koneman et al. Color Atlas and Textbook of Diagnostic Microbiology, Lippincott


Treatment prevention and control e ewingii and a phagocytophilum l.jpg
Treatment, Prevention and Control AnaplasmosisE. ewingii and A. phagocytophilum

  • Doxycycline

  • Avoidance of ticks


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Coxiella Anaplasmosis


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Coxiella burnetii Anaplasmosis

  • Q fever (Q for query)

Fluorescent-Ab Stain

From: G. Wistreich, Microbiology Perspectives, Prentice Hall


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Replication of AnaplasmosisCoxiella burnetii

  • Infection of macrophages

  • Survival in phagolysosome

  • Replication

  • Lysis of cell


Pathogenesis and immunity c burnetii l.jpg
Pathogenesis and Immunity - AnaplasmosisC. burnetii

  • Inhalation of airborne particles (ticks are the primary vector in animals)

  • Multiplication in lungs and dissemination to other organs

  • Pneumonia and granulomatous hepatitis in severe cases

  • In chronic disease immune complexes may play a role in pathogenesis

  • Cellular immunity is important in recovery


Pathogenesis and immunity c burnetii60 l.jpg
Pathogenesis and Immunity - AnaplasmosisC. burnetii

  • Phase variation in LPS

    • Acute disease - Antibodies to phase II antigen

    • Chronic disease - Antibodies to both phase I and phase II antigens


Epidemiology c burnetii q fever l.jpg
Epidemiology - AnaplasmosisC. burnetiiQ fever

  • Stable “spore like”

  • Infects many animals including sheep goats, cattle, and cats

  • High titers in placentas of infected animals

  • Persists in soil

  • Found in milk of infected animals

  • No arthropod vector (ticks in animals)

  • Disease of ranchers, veterinarians and abattoir workers


Epidemiology c burnetii l.jpg
Epidemiology – AnaplasmosisC. burnetii

Notifiable in <40 states


Clinical syndrome q fever l.jpg
Clinical Syndrome - Q Fever Anaplasmosis

  • Acute Q fever

    • Can be mild or asymptomatic

    • fever, chills, headache and myalgia

    • Respiratory symptoms usually mild (atypical pneumonia)

    • Hepatomegaly and splenomegaly can be observed

    • Granulomas in the liver are observed histologically

  • Chronic Q fever

    • Typically presents as endocarditis on a damaged heart valve

    • Prognosis is poor


Laboratory diagnosis c burnetii l.jpg
Laboratory Diagnosis - AnaplasmosisC. burnetii

  • Serology

    • Acute disease - Ab to phase II antigen

    • Chronic disease - Ab to both phase I and phase II antigens


Treatment prevention and control c burnetii l.jpg
Treatment, Prevention and Control AnaplasmosisC. burnetii

  • Acute Q fever - tetracycline

  • Chronic Q fever - combination of antibiotics

  • Vaccine is available but it is not approved for use in the USA


Case study coxiella burnetii l.jpg
Case Study – AnaplasmosisCoxiella burnetii

  • A 56 year-old woman presented with a high fever (104o), hepatomegaly and elevated liver enzymes

  • Diagnosis: Acute cholecystitis; cholecystectomy performed

  • Patient’s symptoms persisted

  • Chest CT scan performed 4 weeks later revealed nonspecific interstitial lung disease.

  • Serum samples obtained at the time of the CT scan and 6 weeks later revealed antibodies to C. burnetii phase II antigens

  • Her husband also developed a febrile illness 3 days after her illness started and his serum samples revealed the presence of antibodies to C. burnetii phase II antigens

  • The patients were both treated with doxycycline and their symptoms resolved

  • They did not own livestock but drove on an unpaved road past a neighbor who raised goats.

  • The goats tested positive for antibodies to C. burnetii


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Bartonella Anaplasmosis


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Microbiology - AnaplasmosisBartonella

  • Small Gram-negative aerobic bacilli

  • Difficult to culture

  • Infect animals but do not cause disease in animals

  • Insects are thought to be the vectors in human disease

  • Some species infect erythrocytes other attach to cells


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Bartonella quintana Anaplasmosis

  • Trench fever

    • Shin-bone fever

    • 5 day fever


Epidemiology b quintana trench fever l.jpg
Epidemiology - AnaplasmosisB. quintanaTrench Fever

  • Associated with war and famine

  • Vector - human body louse

    • Organism found in feces

  • Reservoir - humans

    • No transovarian transmission

    • Cycle - human to louse to human


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Clinical Syndrome - Trench Fever Anaplasmosis

  • Infection may be asymptomatic or severe

  • Sudden onset of fever, chills, headache and myalgia

  • Severe pain in the tibia (shin-bone fever)

  • Symptoms may appear at 5 day intervals (5 day fever)

  • Maculopapular rash may or may not develop on the trunk

  • Mortality rates very low.


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Laboratory Diagnosis - AnaplasmosisB. quintana

  • Serology - reference laboratories

  • PCR - reference laboratories


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Treatment, Prevention and Control AnaplasmosisB. quintana

  • Various antibiotics

  • Control of body louse


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Bartonella henselae Anaplasmosis

  • Cat-scratch disease


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Epidemiology - AnaplasmosisB. henselaeCat-scratch Disease

  • Acquired from cat bite or scratch and possibly from cat fleas


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Clinical Syndrome AnaplasmosisCat-scratch Disease

  • Benign disease

  • Chronic regional lymphadenopathy


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Laboratory Diagnosis - AnaplasmosisB. henselae

  • Serology


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Treatment - AnaplasmosisB.henselae

  • Does not respond to antimicrobial therapy